In the initial project, Pareto leveraged its Revenue Integrity solution to identify and prioritize data quality issues impacting Oak Street Health’s final risk adjustment factor (“RAF”) scores for the 2018 performance year. Because most of the encounter submission process exists within health plan operations, Pareto also supported Oak Street Health’s efforts to collect the necessary datasets from one of their health plan partners to evaluate submission accuracy.

Using the Revenue Integrity solution, Pareto identified data quality issues and clustered them into multiple root causes to prioritize for remediation. Given that this evaluation only covered members from one health plan partner, the estimated opportunity across the full MA population will result in additional improvements for Oak Street Health.

“Oak Street Health invests in providing our patients services that significantly improve their healthcare experience and outcomes,” said Mike Pykosz, CEO of Oak Street Health. “To continue and increase these needed investments, realizing the appropriate revenue based on the disease states we manage is imperative. We remain impressed with the effectiveness of Pareto’s solutions and their ability to identify and prioritize opportunities for us to improve performance.”

As a highly innovative provider organization, Oak Street Health recognizes that revenue performance is impacted by a number of key factors and processes, requiring a more holistic approach. As part of the expanded partnership, Pareto will be deploying its Revenue Integrity solution across Oak Street Health’s MA population for both RAPS and Encounter Data System (EDS) submissions, as well as discrepancies specific to End-Stage Renal Disease (ESRD) entitlement determinations.

“It is our fundamental belief that, in the world of delegated risk models, provider organizations must be proactive in measuring, reviewing, analyzing and improving key processes that impact revenue accuracy to ensure accurate capitation payments,” said John Steele, CEO of Pareto Intelligence. “Oak Street Health is ahead of the game in adopting this approach and will be able to continue to invest in improving their patient’s experience and outcomes.”

As the industry continues to move towards value-based reimbursement, providers will take on increasing levels of risk, requiring a new perspective on capturing complete and accurate revenue. To learn more about Pareto’s Revenue Integrity solution for risk-bearing providers, visit ParetoIntel.com.

About Oak Street HealthOak Street Health is a fast-growing and innovative network of primary care centers for adults on Medicare designed to make healthcare more personal, equitable and accountable for all. Oak Street Health centers offer much more than a standard visit with a doctor. From providing transportation to and from appointments, insurance education, and supplemental services such as podiatry, behavioral health, and in-center pharmacies, the organization is closing critical gaps in the traditional healthcare experience. To encourage social wellness, each center hosts hundreds of social, fitness, and learning activities throughout the year. These services, coupled with Oak Street Health’s focus on quality of care instead of volume of services, has led to a 44 percent reduction in patient hospital admissions and a 46 percent reduction in patient emergency room visits. Today, the organization serves more than 200 communities across the United States with one mission at its core – to rebuild healthcare as it should be.

About Pareto IntelligencePareto Intelligence is a leading healthcare technology company modernizing the way health plans and providers succeed in value-based care. We deliver analytics, technology and advisory solutions to help our clients achieve complete and accurate revenue, communicate critical patient information seamlessly, activate clinical and claims data, and make more informed strategic decisions.